A Study of Glomerullar Minimal Lesion and Minimal Mesangial Proliferation with or without Nephrotic Syndrome; Pathologic, Immunopathologic and Clinical Correlations

A total of 394 cases of minimal lesion were reviewed and reassessed clinically and by laboratory investiga- tion, for 4 years from 1979 to 1982. Association with nephrotic syndrome is significantly higher in the cases with histologically normal-appearing mesangium than in the cases with mesangial proliferation. In 43% of the cases of minimal lesion, a minimal but prominent mesangial deposit of Immunoglobulin M with or without C3 deposit was found, and frequently accompanied with nephrotic syndrome, which is not sufficient to accept the condition as a specific disease entity such as "IgM Nephropathy" in our present study. Minimal lesion with a minimal but unmistakable deposit of lgA on the mesangium was noted less frequently and was accompanied or unaccompanied by nephrotic syndrome, a condition which call for an investigation clarify the characteristics and the extent of lgA(Berger's) nephropathy. Response to steroids in minimal lesion nephrotic syndrome was better in children and in the cases without mesangial proliferation, but was unrelated to either hematuria or immunoglobulin deposit. However, the cases with mesangial proliferation are significantly lesser in therapeutic response. Transformation to another morphological type of original glomerular change during follow-up was not observed in 4 available cases of minimal lesion nephrotic syndrome. Henoch-Sch nlein purpura was seen more commonly in children, and lgA(Berger's) nephropathy more commonly in adults.

Diagnostic Value of Serum Immunoglobulins in Glomerulonephritis

Serum immunoglobulin concenatrations were measured in 156 patients with various types of glomerulonephritis such as acute poststreptococcal glomerulonephritis, minimal lesion nephrotic syndrome and Henoch-Sch?lein purpura nephritis. 1) Serum IgG level was above normal mean in acute poststreptococcal glomerulonephritis, and normal range in Henoch-Scholein purpura nephritis. Serum IgG concentrations were significantly reduced in minimal lesion nephrotic syndrome. 2) Serum IgA concentrations were normal limit in minimal lesion nephrotic syndrome. In one-forth of acute poststreptococcal glomerulonephritis and one-half of Henoch-Sch?lein purpura nephritis, serum IgA concentrations were elevated. 3) Serum IgM concentrations were normal in acute poststreptococcal glomerulonephritis, minimal lesion nephrotic syndrome and Henoch-Sch?lein purpura nephritis. We concluded that serum immunoglobulin concentrations were not useful as an aid in diagnosing glomerulonephritis.

HLA Type in Minimal Lesion Nephrotic Syndrome (MLNS) in Childhood

Association of HLA antigens with certain diseases provide insights into genetically determined susceptibility to disease. Although nephrotic syndrome is one of the commonest diseases, it is poorly understood. A group of 57 patients suffering from a minimal lesion nephrotic syndrome (33 patients) and mesangioproliferative glomerulonephritis (24 patients) was studied for immunologic markers. The incidence of HLA-A w 24 is significantly greater in the minimal lesion nephrotic syndrome patients than in controls (18.7% in patients, 0% in controls, p < 0.01). This report fails to show a high incidence of specific HLA antigen in mesangioproliferative glomerulonephritis patients. We believe that the high incidence of HLA-Aw 24 in minimal lesion nephrotic syndrome is indicative of a congenital predisposition to nephrotic syndrome.